Treatment of Left-Sided Colonic Diverticulitis
Publication Date: June 1, 2020
Last Updated: March 14, 2022
Recommendations
INITIAL EVALUATION OF ACUTE DIVERTICULITIS
1. The initial evaluation of a patient with suspected acute diverticulitis should include a problem-specific history and physical examination and appropriate laboratory evaluation. (1C)
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2. CT scan of the abdomen and pelvis is the most appropriate initial imaging modality in the assessment of suspected diverticulitis. (1B)
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3. Ultrasound and MRI can be useful alternatives in the initial evaluation of a patient with suspected acute diverticulitis when CT imaging is not available or is contraindicated. (1C)
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MEDICAL MANAGEMENT OF ACUTE DIVERTICULITIS
1. Selected patients with uncomplicated diverticulitis can be treated without antibiotics. (1A)
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2. Nonoperative treatment of diverticulitis may include antibiotics. (1C)
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3. Image-guided percutaneous drainage is usually recommended for stable patients with abscesses >3 cm in size. (1B)
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4. Tobacco cessation, reduced meat intake, physical activity and weight loss are recommended interventions to potentially reduce the risk of diverticulitis. (1C)
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5. Mesalamine, rifaximin, and probiotics are not typically recommended to reduce the risk of diverticulitis recurrence but may be effective in reducing chronic symptoms. (2B)
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EVALUATION AFTER RECOVERY FROM ACUTE DIVERTICULITIS
1. After resolution of an episode of acute complicated diverticulitis, the colon should typically be endoscopically evaluated to confirm the diagnosis if a colonoscopy has not been performed recently. (1C)
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ELECTIVE SURGERY FOR ACUTE DIVERTICULITIS
1. After successful nonoperative treatment of a diverticular abscess, elective resection should typically be considered. (1B)
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2. Elective colectomy should typically be recommended for patients with diverticulitis complicated by fistula, obstruction, or stricture. (1B)
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3. Elective resection based on young age at presentation is not recommended.
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4. The decision to recommend elective sigmoid colectomy after recovery from uncomplicated acute diverticulitis should be individualized. (1B)
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5. The decision to offer sigmoid colectomy after recovery from uncomplicated acute diverticulitis in immunosuppressed patients should be individualized. (1C)
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EMERGENCY SURGERY FOR ACUTE DIVERTICULITIS
1. Urgent sigmoid colectomy is typically advised for patients with diffuse peritonitis or for those in whom nonoperative management of acute diverticulitis fails. (1C)
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2. Following resection, the decision to restore bowel continuity should incorporate patient factors, intraoperative factors, and surgeon preference. (1B)
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LAPAROSCOPIC LAVAGE
1. Laparoscopic lavage is not recommended in patients with feculent peritonitis; rather, colectomy should typically be performed in this situation. (1A)
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2. In patients with purulent peritonitis, colectomy is preferred over laparoscopic lavage. Laparoscopic lavage is associated with higher rates of secondary intervention in comparison with colectomy. (1A)
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TECHNICAL CONSIDERATIONS
1. The extent of elective resection should include the entire sigmoid colon with margins of healthy colon and rectum. (1C)
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2. When expertise is available, a minimally invasive approach to colectomy for diverticulitis is preferred. (1A)
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Recommendation Grading
Overview
Title
Treatment of Left-Sided Colonic Diverticulitis
Authoring Organization
American Society of Colon and Rectal Surgeons
Publication Month/Year
June 1, 2020
Last Updated Month/Year
February 5, 2024
Supplemental Implementation Tools
Document Type
Guideline
External Publication Status
Published
Country of Publication
US
Inclusion Criteria
Female, Male, Adolescent, Adult, Child, Infant, Older adult
Health Care Settings
Hospital, Operating and recovery room, Outpatient
Intended Users
Dietician nutritionist, nurse, nurse practitioner, physician, physician assistant
Scope
Assessment and screening, Management, Treatment
Diseases/Conditions (MeSH)
D004239 - Diverticulitis, Colonic
Keywords
diverticulitis, Colon Diverticulosis, Laparoscopic Lavage
Supplemental Methodology Resources
Methodology
Number of Source Documents
168
Literature Search Start Date
January 1, 2013
Literature Search End Date
October 25, 2019